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Endocrinology, Diabetes and Metabolism: Services

UF Health Endocrinology, Diabetes and Metabolism at Jacksonville provides consultations and serves as a resource for all forms of acute and chronic hormonal and metabolic conditions, including:


Adrenal disease

The adrenal gland is responsible for making hormones that control blood pressure and help during physically stressful circumstances. Health problems including hypertension develop when excessive amounts of these hormones are produced. The outer portions of the adrenal gland make stress hormones, such as cortisol, a form of steroid, and aldosterone, a hormone responsible for retaining salt. The inner portion makes adrenalin. Too much of any of these can result in long-term debilitating disease. Disorders of blood pressure may be seen with abnormal adrenal gland function.

Evaluation of adrenal disease involves testing for imbalance of the hormones and imaging of the adrenal glands. The adrenal gland hormones, when deficient, are easily replaced.

Patients are also referred to the division when diagnostic imaging of the abdomen reveals the presence of a growth on the adrenal gland. Further testing is performed to establish the size of the gland and what, if any, hormones are being made in excess. Surgical treatment is based on the size, growth and hormone production of the adrenal lesion.

Diabetes Mellitus

Energy in the form of fat and sugar is constantly moving from the food we eat to storage in fat, liver or muscle to be used by the body for growth, activity or maintenance. Complicated systems of hormones that include insulin make possible the transition from food into energy. Diabetes mellitus results when insulin produced by the pancreas is no longer able to move the sugar (energy) from the blood stream to the proper places. Blood sugar levels rise first after eating, then throughout the day in patients with diabetes.

Our initial approach, in collaboration with our dieticians, is to use medical nutrition therapy and exercise to promote better blood sugar control. When well-established goals of therapy are not met, medication may be added to prevent or delay the problems of diabetes—blindness, kidney failure and nerve damage. Patients are assessed for level of blood sugar control and evidence of complications of diabetes, as well as conditions that may be present at the same time, such as hypertension, high cholesterol and thyroid disease. A multi-disciplinary team that includes a dietician, diabetes educator, pharmacist and endocrinologist are available for consultation to reach optimum blood sugar control. Other tools used in the treatment of diabetes include 24-hour glucose monitoring and intensive insulin therapy. Particular attention is paid to educating patients and monitoring of diabetes and foot problems.

Diabetes Education
The division offers a complete self-management education program coordinated by a certified diabetes educator. The 8-hour class includes an overview of diabetes, coping with the disease, nutrition, monitoring your condition, medications, sick days and community resources. Individual and small-group sessions cover:

  • Carbohydrate counting
  • Continuous glucose monitoring
  • Gestational diabetes/pregnancy complicated by diabetes
  • Insulin instruction
  • Insulin pump evaluation, training and management
  • Intensive insulin therapy instruction
  • Monitoring and use of results

Electrolyte abnormalities

Conditions of elevated or low blood electrolytes, such as sodium, potassium, calcium, magnesium or phosphorus may severely affect quality of life. Abnormal electrolyte levels in the blood cause a variety of problems, including abnormal functioning of nerve and muscle tissue to kidney stones. Endocrinologists are uniquely trained to evaluate and treat these problems, as well as a variety of disorders that cause changes in the amount of acid/base in the blood stream, or pH.

Gonadal disease (ovary and testicle)

Many patients come to an endocrinologist due to loss of sex hormones, which may cause hot flashes, depression and the absence of menstrual cycles in women, or sexual dysfunction and fatigue in men. A less-recognized effect of sex hormone loss is bone loss. An evaluation is performed to determine whether starting hormone therapy would be beneficial.

Other conditions related to abnormal sex hormone production include polycystic ovary syndrome, hirsutism, gynecomastia, steroid hormone enzyme deficiencies and congenital adrenal hyperplasia. UF endocrinologists will determine the presence and cause of low sex hormone and will discuss the risks and benefits of hormonal therapy.

Hypoglycemia

Hypoglycemia, or low blood sugar, results from an inadequate supply of nutrients, increased demand for nutrients or both. Often a feeling of tiredness may be attributed to hypoglycemia, but fortunately true hypoglycemia is uncommon.

Endocrinology is at the forefront of diagnosing and treating this disorder. Many times, lifestyle modification is all that is needed to achieve normal blood sugar levels. More comprehensive evaluation is available in our clinics for patients with continued symptoms or severe hypoglycemia.

Lipid abnormalities

Efficient transportation of energy in the form of carbohydrate or lipid is key to high-level functioning. Changes in this system may result in heart disease and/or pancreatitis. Endocrinologists specialize in both the common causes of lipid abnormalities associated with diabetes and rare disorders of triglyceride and cholesterol transport. Therapy focuses on treating underlying problems, such as low thyroid or diabetes, and instruction in lifestyle management. Medication is added or adjusted as required to meet treatment goals. Physicians also assess cardiac risk and make referrals to Cardiology as necessary.

Metabolic Syndrome

Despite efforts to reduce the rapid climb in weight of the United States population, metabolic syndrome, a combination of high blood sugar, high cholesterol, elevated blood pressure and obesity, continues to increase the risk of heart disease, stroke and amputation. Based on current studies, metabolic syndrome begins in childhood. Patient assessment for metabolic syndrome should start early, before evidence of organ damage occurs. Certain groups of patients, including overweight individuals, are at higher risk for this problem.

The evaluation for metabolic syndrome begins with a thorough medical history regarding food intake, activity level, smoking and family members with this condition. The examination includes an evaluation of blood pressure, eyes, nerves and cardiovascular function. Laboratory testing is required to determine the presence of elevated cholesterol, evaluate kidney function and blood glucose level. Physicians review the test results with their patients and educate them on symptoms of metabolic syndrome to be aware of and steps they can take to reduce their risk of developing heart disease or stroke.

Parathyroid disease

Calcium and phosphorus levels in the blood are kept in very tight balance. Too little calcium may interfere with nerve function; too much may cause kidney stones or the deposit of calcium in places that cause pain or interfere with the flow of blood. Parathyroid diseases, both over secretion or under secretion of parathyroid hormone, are managed by endocrinologists. Evaluation involves an assessment of fracture risk most often with bone densitometry by dual X-ray absorptiometry (DXA), as well as blood and urine tests to determine the location of the problem. Both surgical and medical options are weighed to accomplish the best outcome for the patient.

Pituitary disease

The pituitary, or "master" gland, controls many vital communications systems in the body. Hormones produced by the pituitary control, among other things, stress response, thyroid, growth, male and female hormones and water balance. Pituitary function may be affected by a number of conditions, including growths in the pituitary, prior radiation or trauma.

After a thorough history and physical exam, special laboratory dynamic testing to asses function may be required. Due to the close proximity of the pituitary gland to vital structures - the brain, nerves and eyes - the size of the gland is measured by magnetic resonance imaging (MRI) or computed tomography (CT) to complete the evaluation. Specific treatment of hormone deficiencies or excess hormone production is routinely addressed by the physicians, who work closely with Neurosurgery, Otolaryngology, Ophthalmology and Radiation Oncology to achieve the best outcome for patients with pituitary disease. An emerging area of investigation is the hypothalamus, a portion of the brain that controls both pituitary and whole body well-being.

Skeletal disease

Osteoporosis is the most common metabolic bone disease. The evaluation includes reviewing risk factors for bone loss, balance, dietary history, exercise history and previous fracture. Your height will be measured. After a physical exam, you will be counseled on how to avoid falls and ways to make your bones stronger.

We treat athletes with recurring fractures and osteoporosis that may be caused by a variety of medications, and have expertise in the management of male osteoporosis, hyperparathyroidism, osteomalacia, Paget's disease of bone, osteogenesis imperfecta and osteopetrosis. Available testing includes genetic testing and bone biopsy.

Thyroid disease

The thyroid gland sits below the voice box. Out of balance thyroid hormone affects the whole body. Our physicians are trained to recognize the often subtle hints of thyroid disease. In addition, we offer diagnosis and treatment of large thyroid, goiter, thyroid nodules and thyroid cancer. These conditions are evaluated through blood testing and, if indicated, thyroid ultrasound. Fine needle aspiration of the thyroid is a procedure that helps the endocrinologist determine the best approach for the patient. Candidates for fine needle aspiration of the thyroid include patients with thyroid nodules of sufficient size, prior radiation treatment or a family history of thyroid cancer.

Other disorders

The UF Division of Endocrinology serves as a resource in the evaluation and management of hormone producing tumors, endocrine emergencies (hypercalcemia, hypocalcemia, thyroid storm, myxedema coma, adrenal insufficiency and pituitary apoplexy) and genetic disorders of metabolism, including those related to carbohydrate, lipid and protein.